Reform of the NHS

It is a reflection of the parlous state of the NHS that it so dominates political debate. Rishi Sunak devoted a sizeable chunk of his speech to the CBI yesterday to the health service’s shortcomings and what to do about them. Far from being “the envy of the world”, the NHS is turning into a national disaster area of overcrowded hospitals, crammed A&E units, long waiting lists, delayed ambulances and late diagnoses.

The Prime Minister said one answer was to “radically innovate how we do things… to improve the quality and speed of care and make the money we invest in the NHS go further”. Patients, he said, would be given choices about where to access care, informed by “radical transparency about the performance of our healthcare system”. What does any of this mean? We have travelled this road for decades – of league tables, of setting targets for improvement – yet the system has continued to deteriorate despite the vast sums invested.

In Scotland, NHS leaders are at least prepared to contemplate something different, even if the politicians refuse to consider change however poorly the health service performs. They have discussed moving to a two-tier system, allowing people to pay for treatment, as many already do in the private sector. Confidential minutes showed that they feared for the sustainability of Scotland’s health services in its present form.

But the politicians will have none of it. Mr Sunak said that whatever reforms are pursued, the founding principle of treatment free at the point of delivery would remain. Nicola Sturgeon, Scotland’s First Minister, said this was “not up for debate”. It is time it was.